Major obstacles for lung transplantation. Lung transplantation has become the mainstay of therapy for most end-stage lung diseases. However, the number of patients on the waiting list exceeds the number of organs available (1). More than 80% of donor lungs are potentially injured and therefore not considered suitable for transplantation. Furthermore, when a lung is found suitable for transplantation, the recipient may suffer from Primary Graft Dysfunction (PGD). PGD affects up to 25% of all lung transplant procedures. Currently there is no proven preventive therapy. PGD arises in the acute phase following lung transplantation and is characterized by significant deterioration of gas exchange and chest X-ray infiltrate. This condition is known not only for its contribution to early mortality but also for its impact on mid- and long-term survival (acute and chronic graft dysfunction) (2-4).
Clinical Trial of Ex-Vivo Lung Perfusion. With the use of normothermic ex vivo lung perfusion (EVLP), the retrieved donor lung can be perfused in an ex vivo circuit, providing an opportunity to reassess its function before transplantation. The first prospective clinical trial of EVLP has been performed, demonstrating the safety of the procedure (5). In this study, EVLP was applied to high-risk donor lungs which are often rejected for transplantation due to fear of PGD and compared results with a conventional lung transplantation group. It was shown that PGD occurrence was not statistically different. Thus, it was shown that EVLP expands the donor pool through the use of marginal lungs. Even though the percentage of PGD occurrence after EVLP tended to be lower compared to conventional lung transplantation, the number of lungs that developed PGD after EVLP is not zero (5). Analysis of these lungs showing poor results could be the key for future targeted treatment strategies to improve the rate of utilization of lung and post-operative outcomes.